Provider Demographics
NPI:1285176172
Name:BURANDT, LEAH NICHOLE (PA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:NICHOLE
Last Name:BURANDT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 LA CROSSE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-1783
Mailing Address - Country:US
Mailing Address - Phone:512-877-5333
Mailing Address - Fax:503-954-2122
Practice Address - Street 1:5915 LA CROSSE AVE STE 140
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78739-1783
Practice Address - Country:US
Practice Address - Phone:512-877-5333
Practice Address - Fax:503-954-2122
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10800363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical